Background: The
roll-out of medical male circumcision (MMC) is progressing in Southern and Eastern Africa. Little is known about the effect of this
roll-out on HIV infection among women. The objective of this study was to
assess the association between women''s HIV incidence and the circumcision
status of their male partners in a South African township where the roll-out has
been ongoing since 2008.Methods: This study was conducted in the township of Orange Farm
(South Africa),
where male circumcision (MC) prevalence has increased from 12% to 53% in recent
years and where circumcised men have a 48% reduction in HIV prevalence in
comparison with uncircumcised men. Data from three community-based cross
sectional biomedical surveys conducted in 2007, 2010 and 2012 were combined.
HIV incidence was studied among young women as a function of the MC status of
their sexual partners. Age-specific HIV incidence rate were obtained using
classical infected-susceptible mathematical modeling. The predicted HIV
prevalence rate by age was fitted on the observed HIV prevalence rate by the
likelihood estimation method weighted to adjust on covariates such as lifetime
number of partners. 95% confidence intervals were obtained using the bootstrap
technique.Results: Among 2452 women aged 15 to 29 having had only
circumcised partners and other women ever having had sex, HIV prevalence rate
was 17.8% (162/910) and 30.4% (469/1542), respectively. The association between
HIV prevalence among women and partners´ MC status has been reported elsewhere.
HIV incidence rate was 0.037 (95% CI: 0.031 to 0.043)
and 0.047 (95% CI: 0.043 to 0.050), respectively, which corresponds to an adjusted incidence rate ratio of 0.80 (95% CI: 0.66
to 0.94). The adjusted reduction of HIV incidence rate was 20.3% (95% CI: 5.8%
to 33.8%). Among 4538 women aged 15 to 49 the adjusted reduction was 16.9%
(1.1% to 31.0%).Conclusions: Findings
reveal for the first time that MMC roll-out is associated with a reduction of
HIV incidence among women having only circumcised sexual partners, which is
consistent with the observed lower HIV prevalence among circumcised men. The roll-out
of MMC may benefit women and should be accelerated.